女性尿道憩室的病理特征与慢性感染

Pathological features and chronic infection of female urethral diverticulum

目的探讨女性尿道憩室(FUD)的临床分型、诊治思路及病原病理特征,为女性尿道憩室的病原研究,合理诊疗提供依据。方法收集2011年1月-2022年12月中山大学附属第一医院和中山大学孙逸仙纪念医院泌尿外科收治的29例FUD患者的病例资料,根据MRI表现分为单纯型(轴位影像憩室环绕尿道<180°)(n=18)和复杂型(环绕尿道>180°)(n=11),两组患者均进行憩室切除和围术期预防性抗感染治疗。对术前临床表现、病理检查结果和术后复查结果进行分析。结果复杂型FUD在尿痛、压力性尿失禁阳性率高于单纯型,差异均有统计学意义(P<0.1)。29例FUD患者中27例接受手术治疗,术后切口愈合状况均良好。出院1月后随访,提示治疗与患者尿频、尿痛、排尿后滴沥、反复尿路感染、压力性尿失禁的缓解之间的相关性差异有统计学意义(P均<0.05)。憩室囊壁病理表现显示,上皮组织缺失和不典型增生在复杂型憩室中均更为常见,尿道移行上皮伴炎细胞浸润在单纯型憩室中更为多见,差异均有统计学意义(P均<0.05)。结论利用MRI检查对女性尿道憩室进行分型,可指导临床诊治。在治疗中使用抗生素控制感染,通过外科手术切除憩室囊,封闭憩室颈口,能有效解除症状。

Objective To explore the clinical classification,diagnosis and treatment of female urethral diverticulum(FUD),and to provide a basis for the etiological research and reasonable diagnosis and treatment of female urethral diverticulum.Methods From Jan.2011 to Dec.2022,29 female patients with FUD were treated in the Department of Urology,the First Affiliated Hospital of Sun Yat-sen University and Sun Yat-sen Memorial Hospital of Sun Yat-sen University.Case data of the patients with FUD were reviewed,and the therapeutic effect was summarized.Patients were classified into simple diverticulum(extend around the urethra<180°)(n=18)and complex(extend around the urethra>180°,horseshoe shape or circumferential)(n=11).All patients underwent diverticulectomy and perioperative prophylactic anti-infection treatment.The preoperative clinical manifestations,pathological examination results and postoperative review results were analyzed.Results The positive rates of frequent urination,dysuria,recurrent urinary tract infection,stress urinary incontinence and leukocytosis were significantly different between simple FUD and complicated FUD.The difference was statistically significant(P<0.1).The patient underwent transvaginal urethral diverticulectomy and perioperative prophylactic anti-infection treatment.The follow-up one month after discharge showed that the treatment was significantly correlated with the relief of symptoms of dysuria,and stress urinary incontinence.The difference was statistically significant(P<0.05).Epithelial loss and atypical hyperplasia were more common in complex diverticulum,and urethral transitional epithelium with inflammatory cell infiltration was more common in simple diverticulum.The difference was statistically significant(P<0.05).Conclusions The classification of female urethral diverticulum by MRI can guide clinical diagnosis and treatment.The use of antibiotics to control the infection and surgical removal of the diverticulum sac and closure of the diverticulum neck can effectively relieve the symptoms.